婴儿下咽部胃黏膜异位症引发咽喉反流症状1例并文献回顾

doi:10.6040/j.issn.1673-3770.0.2024.110

摘要/Abstract

摘要： 目的探讨下咽部胃黏膜异位引发咽喉反流症状的诊断及治疗方案。方法复习1例4月龄男婴的病历资料。该患儿因“喉鸣伴发作性呼吸困难”入院。根据患儿病史、喉镜检查结果、RSI量表评分诊断为咽喉反流。电子喉镜检查见喉和食管入口交界处2粒球形肿物,行手术切除。病理提示肿物为异位胃黏膜。结果术后3个月、1年及3年复诊,患儿呼吸及吞咽功能均得到明显改善,肿物无复发。结论下咽部胃黏膜异位罕见报道。在诊断儿童咽喉反流过程中,若发现咽喉部黏膜病变或肿物生成,需警惕胃黏膜异位症可能。治疗上以手术切除肿物为主,治疗期间可辅以质子泵抑制剂控制反流症状。

关键词: 胃黏膜异位症, 咽喉反流, 喉鸣, 发作性呼吸困难, 儿童

Abstract: Objective To explore the diagnosis and treatment options for pharyngeal reflux symptoms caused by gastric mucosal ectasia in the hypopharynx. Methods The medical records of a 4-month-old boy were reviewed. The child was admitted to the hospital with "laryngeal tinnitus with episodic dyspnea". The diagnosis of laryngopharyngeal reflux was made on the basis of the child's medical history, laryngoscopic findings, and the RSI scale score. Two spherical masses at the junction of the larynx and the esophageal inlet were examined by electron laryngoscopy and surgically removed. Pathology suggested that the masses were an ectopic gastric mucosa. Results At follow-up examinations at 3 months, 1 year and 3 years after surgery, the children's respiratory and swallowing functions improved significantly and there was no recurrence of the masses. Conclusion Ectopic gastric mucosa in the hypopharynx is rarely reported. In the process of diagnosing pharyngeal reflux in children, if mucosal lesions or masses are found in the pharynx, the possibility of gastric mucosal ectasia should be alerted. Surgical resection of the mass is the mainstay of treatment, and proton pump inhibitors can be used to control reflux symptoms during treatment.

Key words: Heterotopic gastric mucosa, Pharyngeal reflux, Laryngeal ringing, Episodes of dyspnoea, Children

中图分类号:

R766.5

姚婷婷,张德伦,李兰. 婴儿下咽部胃黏膜异位症引发咽喉反流症状1例并文献回顾[J]. 山东大学耳鼻喉眼学报, 2024, 38(6): 126-130.

YAO Tingting, ZHANG Delun, LI Lan. A case of infantile hypopharyngeal gastric mucosal ectasia causing pharyngeal reflux symptoms and review of the literature[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2024, 38(6): 126-130.

参考文献

[1] Itai Y, Kogure T, Akiyama H. Ectopic gastric mucosa of the esophagus(1st. report)[J]. JJpnBronchoesophagolSoc, 1972, 23(4): 207-212. doi:10.2468/jbes.23.207
[2] 中华耳鼻咽喉头颈外科杂志编辑委员会咽喉组,中华医学会耳鼻咽喉头颈外科学分会咽喉学组,中华医学会耳鼻咽喉头颈外科学分会嗓音学组. 咽喉反流性疾病诊断与治疗专家共识(2022年,修订版)[J]. 中华耳鼻咽喉头颈外科杂志,2022,57(10):1149-1172. DOI:10.3760/cma.j.cn115330-20220711-00428
[3] Feurle GE, Helmstaedter V, Buehring A, et al. Distinct immunohistochemical findings in columnar epithelium of esophageal inlet patch and of Barrett's esophagus[J]. Dig Dis Sci, 1990, 35(1): 86-92. doi:10.1007/BF01537228
[4] Mannan AASR, Vieth M, Khararjian A, et al. The outlet patch: gastric heterotopia of the colorectum and anus[J]. Histopathology, 2018, 73(2): 220-229. doi:10.1111/his.13632
[5] von Rahden BHA, Stein HJ, Becker K, et al. Heterotopic gastric mucosa of the esophagus: literature-review and proposal of a clinicopathologic classification[J]. Am J Gastroenterol, 2004, 99(3): 543-551. doi:10.1111/j.1572-0241.2004.04082.x
[6] di Palmo E, Cazzato S, Tursini S, et al. A rare association of inlet patch with laryngospasm: a report of two children and literature review[J]. Pediatr Pulmonol, 2011, 46(9): 934-938. doi:10.1002/ppul.21457
[7] Georges A, Coopman S, Rebeuh J, et al. Inlet patch: clinical presentation and outcome in children[J]. J Pediatr Gastroenterol Nutr, 2011, 52(4): 419-423. doi:10.1097/MPG.0b013e3181f2a913
[8] 龙峻标, 于淑霞, 刘绍能. 食管上段异位胃黏膜69例临床分析[J]. 中华消化杂志, 2013, 33(5): 336-338. doi:10.3760/cma.j.issn.0254-1432.2013.05.012
[9] 陈维安, 崔颖鹏, 李春亿, 等. 小儿异位胃粘膜核素显像的诊断价值[J]. 中国儿童保健杂志, 2005, 13(4): 314-315. doi:10.3969/j.issn.1008-6579.2005.04.014 CHEN Weian, CUI Yingpeng, LI Chunyi, et al. Diagnostic value of radionuclide imaging in children with ectopic gastric mucosa[J]. Chinese Journal of Child Health Care, 2005, 13(4): 314-315. doi:10.3969/j.issn.1008-6579.2005.04.014
[10] 靳水, 王瑞华, 刘艳, 等. SPECT/CT显像诊断异位胃黏膜的临床价值[J]. 中华核医学与分子影像杂志, 2016, 36(3): 229-231. doi:10.3760/cma.j.issn.2095-2848.2016.03.006 JIN Shui, WANG Ruihua, LIU Yan, et al. Clinical value of SPECT/CT imaging in the diagnosis of ectopic gastric mucosa[J]. Chinese Journal of Nuclear Medicine and Molecular Imaging, 2016, 36(3): 229-231. doi:10.3760/cma.j.issn.2095-2848.2016.03.006
[11] 吴迪盼盼, 崔新华, 郭颖, 等. 窄带成像技术在咽喉反流诊断中的优势应用[J]. 山东大学耳鼻喉眼学报, 2021, 35(3): 31-36. doi:10.6040/j.issn.1673-3770.1.2020.108 WU Dipanpan, CUI Xinhua, GUO Ying, et al. Narrow band imaging might contribute to the diagnosis of laryngopharyngeal reflux[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2021, 35(3): 31-36. doi:10.6040/j.issn.1673-3770.1.2020.108
[12] 黄娟秀. NBI在食管上段胃粘膜异位症的临床应用[J]. 临床医药文献电子杂志, 2020, 7(32): 125-126. doi:10.16281/j.cnki.jocml.2020.32.110
[13] Yin Y, Li HY, Feng J, et al. Prevalence and clinical and endoscopic characteristics of cervical inlet patch(heterotopic gastric mucosa): a systematic review and meta-analysis[J]. J Clin Gastroenterol, 2022, 56(3): e250-e262. doi:10.1097/MCG.0000000000001516
[14] Romańczyk, M, Budzyń K, Romańczyk, T. et al. Heterotopic Gastric Mucosa in the Proximal Esophagus: Prospective Study and Systematic Review on Relationships with Endoscopic Findings and Clinical Data[J]. Dysphagia, 2023, 38(2): 629-640. doi: 10.1007/s00455-022-10492-8.
[15] Silvers WS, Levine JS, Poole JA, et al. Inlet patch of gastric mucosa in upper esophagus causing chronic cough and vocal cord dysfunction[J]. Ann Allergy Asthma Immunol, 2006, 96(1): 112-115. doi:10.1016/S1081-1206(10)61049-6
[16] Chong VH, Jalihal A. Cervical inlet patch: case series and literature review[J]. South Med J, 2006, 99(8): 865-869. doi:10.1097/01.smj.0000231246.28273.b0
[17] Ayres L, Perring S, Nouraei SAR. A multidisciplinary approach to identifying and managing heterotopic gastric inlet patches[J]. Neurogastroenterol Motil, 2024, 36(4): e14768. doi:10.1111/nmo.14768
[18] 李洪秋, 李红, 常筱颖, 等. 小儿异位胃黏膜致消化道出血的特点及处理[J]. 中国小儿急救医学, 2007, 14(5): 446-447. doi:10.3760/cma.j.issn.1673-4912.2007.05.030 LI Hongqiu, LI Hong, CHANG Xiaoying, et al. Clinical feature and treatment of digestive bleeding with ectopic gastric mucosa in children[J]. Chinese Pediatric Emergency Medicine, 2007, 14(5): 446-447. doi:10.3760/cma.j.issn.1673-4912.2007.05.030
[19] Daher P, Riachy E, Zeidan S, et al. Upper airway obstructive symptoms because of ectopic gastric mucosa in a newborn: a case report[J]. J Pediatr Surg, 2006, 41(8): e7-e9. doi:10.1016/j.jpedsurg.2006.04.005
[20] Weinstock MS, Simons JP, Dohar JE. Heterotopic gastric mucosa of the proximal esophageal(HGMPE)and its potential role in pediatric dysphonia and dysphagia[J]. Int J Pediatr Otorhinolaryngol, 2020, 138: 110271. doi:10.1016/j.ijporl.2020.110271 [PubMed]

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